Abstract
Objectives
Intrauterine contraception (IUC) is safe and highly effective, but its use remains
low. Previous studies have shown that knowledge of IUC among health care providers
(HCPs) is poor and that IUC is recommended to a very limited group of women. This
study sought to investigate attitudes, practices and knowledge regarding IUC among
Swedish HCPs.
Study design
A pretested, national Web survey was emailed to 1157 HCPs who provide contraceptive
counseling in Sweden. The collected data were transferred to IBM SPSS Statistics 20
and analyzed using χ2 test, Fisher’s Exact Test, Student’s t test, and Kendall's tau-b, as appropriate.
Results
A total of 692 individuals (471 midwives and 221 gynecologists) answered the survey,
resulting in a response rate of 60%. Younger HCPs and HCPs who performed a large number
of IUC insertions considered the method applicable for a broad spectrum of women.
Fewer than 30% considered IUC an option for younger women, women with a previous ectopic
pregnancy or women with pelvic inflammatory disease. During insertion, 24% of the
gynecologists and 15% of the midwives used analgesia in the form of paracetamol or
nonsteroidal anti-inflammatory drug, transcutaneous electrical nerve stimulation,
hot water bottles or misoprostol for cervical ripening. HCPs at workplaces with guidelines
for the insertion procedure were more likely to use analgesia and misoprostol. HCPs
who performed a large number of insertions per month reported a greater use of analgesia
and misoprostol (p<.01).
Conclusion
Swedish gynecologists and midwives do not always adhere to scientific evidence and
follow existing guidelines with regard to IUC. Efforts are needed to increase the
number of HCPs offering IUC, especially to young and nulliparous women.
Implications
Greater educational efforts are needed to counter reluctance among HCPs toward using
IUC, especially in young and nulliparous women.
Keywords
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Article info
Publication history
Published online: January 09, 2014
Accepted:
December 23,
2013
Received in revised form:
December 10,
2013
Received:
September 24,
2013
Footnotes
☆Funding: supported by grants from the Stockholm County Council (ALF project) and Karolinska Institutet, Stockholm, Sweden.
☆☆None of the authors have any conflicts of interest.
Identification
Copyright
© 2014 Elsevier Inc. Published by Elsevier Inc. All rights reserved.
